Provider Demographics
NPI:1306308556
Name:NORTHWEST HOLISTIC THERAPIES, P.S.
Entity type:Organization
Organization Name:NORTHWEST HOLISTIC THERAPIES, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:SOPHIA
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-375-0432
Mailing Address - Street 1:18024 49TH PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-5400
Mailing Address - Country:US
Mailing Address - Phone:425-418-2949
Mailing Address - Fax:
Practice Address - Street 1:19125 N CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8035
Practice Address - Country:US
Practice Address - Phone:425-375-0432
Practice Address - Fax:425-740-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty